Healing Tunes the art and science of a Medical Song

FMF Vancouver Nov 2016 OBJECTIVES - Recognize the science between music, medicine and the art of healing -Learn a few tricks to mine your creativity, convert daily medical experiences into lyrics and songs -Learn by example, enjoy a collection of medical songs ranging from hilarious to gut-wrenching This session is for all who might be intrigued by the concept of MEDICAL SONGS learn and be entertained by a couple of old FPs, worlds apart in geography and artistry, but with a communal love of a life enriching song! Ted “ dr j” Jablonski is an award-winning multi-instrumentalist singer- songwriter and family physician in Calgary. He has released nine indie CDs and has numerous television appearances and some radio play on 3 continents. His songwriting is generally inspired by serious themes of illness, death and tragedy, with many cathartic songs about his medical experience. He is currently working on a full length musical. William “BILL” EATON is the famous FP palliative care “Humorologist” from Newfoundland with 3 CD releases and a wealth of performances. He is an articulate and hilarious storyteller and enjoys writing and performing musical comedy – especially with medical twists, themes and content. He is currently working on a blog for young MDs DISCLOSURES None & NONE Music therapy is increasingly recognized as an adjunctive therapy for palliative care, geriatrics, and childhood illnesses.

The use of music and songwriting as a therapeutic tool for physicians (use with patients or purely for self) is less well established – not established at all. It is often said that there is an unusually high number of physicians that are musicians (or perhaps, more correctly, musicians who happen to become doctors). Doctor Musicians

Berlioz Helmholtz Billroth Trandelenberg Auenbrugger Sir Francis Bacon

“The genius of music and of medicine are alike. The function of the physician is to tune the lyre of the human body so that it shall give forth sweet and harmonious sounds” Brain areas activated by listening to music

ATTENTION MEMORY EXPECTATIONS / RULES EMOTION fMRI

Have subjects in fMRI machine Listen to music Listen to rhythm Imagine playing the music Musicians vs non musicians Composite images

Figure 2. Axial slice renderings of mean activations (red/yellow scale bar) and deactivations (blue/green scale bar) associated with improvisation during Scale and Jazz paradigms.

Limb CJ, Braun AR (2008) Neural Substrates of Spontaneous Musical Performance: An fMRI Study of Jazz Improvisation. PLoS ONE 3(2): e1679. doi:10.1371/journal.pone.0001679 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0001679 Music and mental tasks

Functional MRI imaging during mental task switching: Panels A shows brain activation in musically trained children Panels B in untrained children

Responding to rhythm

Right and Left superior temporal areas Left inferior parietal lobe Right operculum

Trained musicians vs untrained Increased activation, while listening to music, in: Pars opercularis Pars triangularis Premotor cortex, Bilateral inferior parietal lobule Left cerebellum

Neurology of music Increased dopamine activity Professional musicians have largest cortex volumes, followed by amateurs then non musicians Fine motor skills improved Greater appreciation of speech syntax Executive functioning and music involve the same brain structures Music as Healing Agent Stroke patients walk sooner if gait timed to a metronome with music of the same beat Music reduces pain in burn patients during dressing changes Age sensitive music grounds people with dementia Music can calm acutely psychotic patients Anxiety, insomnia, stress less with music Listening to music can activate areas of the brain involved in:

ATTENTION MEMORY EXPECTATIONS / RULES EMOTION The reason for this affinity between medicine and music is hard to explain and will continue to be an interesting topic 1. MUSIC has special properties - neurophysiologic 2. These neurophysiolgic changes may have healing properties 3. this healing effect could be useful for us to heal our patients (traditional musical therapy) OR to heal ourselves! (the wounded healer) Many physicians believe in the importance of music and its healing powers but are sometimes the first to abandon it due to the demands of clinical practice, personal and family life. ?more than coincidence that so many medical professionals have very significant connections with music (70%) - formal training (at high level) - ability to play instrument(s) -self-report love of music in their lives ( eg. relaxation / stress reliever ) Even with extensive music backgrounds, songwriting may seem like a daunting goal as the process may appear difficult, poorly defined, and shrouded in mystery. We document information each and every day as a technical part of our jobs.

Can this skill be translated into creative writing and a song ? We are medical doctors - we live, eat and breathe in the world of medicine (and many of us are well versed in music / formally trained) so why not combine actual medical themes with music and we may have the ultimate therapeutic weapon? So what’s a SONG?? So what’s a SONG?? A song, most broadly, is a single (and often standalone) work of music that is typically intended to be sung by the human voice withdistinct and fixed pitches and patterns using sound and silence and a variety of formsthat often include the repetition of sections. Written words created specifically for music or for which music is specifically created, are called lyrics. So what’s a SONG??

A magical marriage between lyrics (some words) and a melody (some notes) SONGWRITING for “older” TYPE A Personality Types Typical SONG(Title) STRUCTURE ??

Intro thematic / none to extravagant Verse multiple / rhyming Chorus one / repetitive (Instrumental) none to extravagant ((Bridge)) lyrical / instrumental Extro thematic / mimics intro EXERCISES IT’S ALL ABOUT EFFECTIVE AND CONCISE COMMUNICATION TOP 5 Simple Exercise

1. NEWSPAPER / TITLE (one phrase) 2. Word in central circle 3. HAIKU (5 / 7 / 5) 4. Title & Emotion (one word / phrase) 5. Voice / Tempo / Style Now convert to everyday life in clinic (or at home or wherever you are)

If I am open – I will see and hear a newspaper full of phrases / ideas / concepts WRITE Write write write write write write write write write write write write write

Write write write write write write write write write write write write write write

Write write write write write write write write write write write write write write write

Write write write write write write write write write write write write write write write write

Write write write write write write write write write write write write write write write write write

Write write write write write write write write write write write write write write write write write write

Write write write write write write write write write write write write write write write write write write write HEALING SONGs EXAMPLES BILL Euthanasia Palliative Care Blues We are the Doctors TED Ode to a Malady NUMB Fix Me Euthanasia song

I heard you say you’re tired of life. You’ve suffered enough with pain and strife The time has come is how I’ll paraphrase ya’ You really want to get out of here. You’ve had enough of medical care It’s bold and it’s unspoken. Euthanasia

Well it’s really not as simple as that. There’s protocol and format You need two willing doctors to appraise ya They’ll him and haw and cogitate. While your poor body degenerates You might die before they decide (on). Euthanasia

The funeral home is never free. And don’t forget the lawyer’s fees Insurance forms and taxes mount to fleece ya The cost of dying’s getting high. It’s not cheap to say goodbye Now you might have to pay (for). Euthanasia

What to write in your obit, or on the death certificate Don’t let these pithy details displease ya Lived a life of great aplomb. Here today tomorrow gone The pope says “Nope’ to a funeral with. Euthanasia ODE TO A MALADY Don’t know how you slipped in When you came to be Never made much fuss Sort of grew on me Somewhere ‘long the line Started banging on the door You threw a temper tantrum Started rolling on the floor They tell me drink this poison They tell me eat these pills They sit and mix their potions It goes against my will They try to build me up While the try to tear you down They save me every time As I watch you drown Why can’t you settle down We could learn to live together Your constant up and down Is worse than the weather You make me scream out loudAlways there, you always hover You make me want to live You’re almost like my lover CHORUS They’re slowing killing Part of me I’m losing you Why can’t they see We’ve been together For so long Tearing us apart Feels so wrong Palliative Care Blues

My name is Dr. Morphine and I do Palliative Care I’ll fill you up with morphine in a manner most sincere I’ll infuse your brain so you won’t feel pain I’m only trying to make you feel good, or at least a bit better In the palliative care we keep your symptoms under control To load you up with heavy drugs is our penultimate goal While your body takes a beating we’ll be holding a family meeting I’m only trying to make you feel good, or at least a bit better My name is Dr. Haldol and I do palliative Care I’ll give you so much Haldol you won’t even know you’re here Instead of scratching and screaming you’ll be drifting and dreaming We’re only trying to make you feel good, or at least a bit better In the palliative care we worry ‘bout your hopes and goals We look after your body and your spirit and your soul You may as well have your say we’re going to do what we do anyway We’re only trying to make you feel good, or at least a bit better NUMB

Tonight – I just gotta feel numb Each day I fight the battle, there’s more to come Tonight - I just want to be numb

Right now – I just gotta get numb Stood up and decided, Why am I still dumb ? Right now - I just need to be numb x2 Getting off, I’m checking out Going down always ends my doubt Had too much, need a break (promise I’ll) Start again when I’m awake Tonight – I just gotta feel numb more than tired beating my own drum Tonight - I just want to be numb CHORUS Tonight– I just gotta get numb Just need to rest, sorry Dad and mom Tonight - I am gonna get numb Right now – I am gonna get numb Right now I’m numb Another BILL EATON TUNE (placeholder) We are the Doctors Now you might die fast you might die slow Fill out a living will so that we will know Just what tests to do. Is home care best for you? Or would you like to die in the ICU? Chorus We are the doctors it’s true We will take care of you We got needles we got pills That will cure up all your ills We are the doctors it’s true We’ll see you if your hemorrhoids start to bleed We’ll ask you personal questions all through emergency Then to the OR you’ll be wheeled where we’ll cure you with our steel Just don’t expect us to ask you how you feel Chorus Come see us if you’ve got a pain in the chest We’ll put you on a waiting list until you arrest Then we’ll slap you in a bed fill you full of tubes and meds And we’ll work on you for two hours after you’re dead Chorus Doctors have always been fascinated by technological achievements and as such are quite pleased when they can order a fancy test or connect a sick person to a machine. Unfortunately the poor patient can get lost behind the flashing lights and bleeping monitors. Much of the health care money spent on you during your life gets spent just before you die. Some say half of a person’s life-time allotment of health care funding gets used up in the last six months of life. For what? FIX ME

There’s a jack hammer pounding In the middle of my skull Why can’t you fix me And my guts are always churning around and around Why can’t you fix me You said you were the expert and you gave me more pills My usually empty pockets are stuffed full with bills You set off major heartburn and I’m still - feeling ill Why don’t you fix me why can’t you fix me My back’s on fire It sizzling down my legs Why can’t you fix me My heart is flipping and flip- lopping away Why can’t you fix me Don’t tell me that its all in my head Don’t tell me that its somehow my fault If you only knew what you were doing You might even be worth your salt why don’t you fix me why can’t you fix me My skin’s so itchy that I’ll tear it to pieces Why can’t you fix me My fingers are tingling So numb can’t stop twitching Why can’t you fix me CHORUS #2 I’m dizzy, sort or spinning And I’m gonna pass out Why can’t you fix me Can’t think, can’t talk And my memory is shot Why can’t you fix me CHORUS #1 Q+A

HECKLING (too late...... ) COMMENTS DISCUSSION THANKS++

FEEDBACK / COMMUNICATION (bring it on!! Ted “ dr j” Jablonski [email protected] William “Bill” Eaton [email protected]